POS1506-HPR SYSTEMATIC LITERATURE REVIEW TO INFORM THE EULAR TASK FORCE FOR RECOMMENDATIONS/POINTS TO CONSIDER FOR THE NON-PHARMACOLOGICAL MANAGEMENT OF SYSTEMIC LUPUS ERYTHEMATOSUS AND SYSTEMIC SCLEROSIS
Authors: I. Parodis, A. Gomez, A. Tsoi, J. Weng Chow, D. Pezzella, C. Girard, T. Stamm, C. Boström
Journal: Annals of the Rheumatic Diseases (2022)

Background The heterogeneity and complexity of the chronic autoimmune diseases systemic lupus erythematosus (SLE) and systemic sclerosis (SSc) necessitate comprehensive person-centred management, including non-pharmacological approaches. Recommendations for non-pharmacological management are currently lacking. Objectives To perform a systematic literature review to inform the EULAR task force for recommendations/points to consider for the non-pharmacological management of adult patients with SLE and SSc. Among research questions formulated by the task force, we aimed at identifying (i) non-pharmacological interventions that have been evaluated and (ii) their target health domains or organ systems. Methods We searched the Medline, Embase, Web of Science Core Collection and CINAHL for articles published between January 2000 and June 2021. From the initial search (n=15,803), 2 researchers independently performed the article selection. Conflicts were discussed until consensus with 2 additional researchers. Subsequent data extraction from the selected articles was performed by 4 researchers, with an overarching guidance by 2 additional researchers. Risk of bias assessment was performed according to Joanna Briggs Institute Critical Appraisal Checklists. Results A total of 111 articles for SLE and 75 for SSc were selected for analysis. Non-pharmacological interventions identified for SLE included physical exercise (n=34), psychological support (n=21), dietary therapy and nutrition (n=15), patient education and self-management (n=14), photoprotection (n=5), medication adherence interventions (n=5), complementary and alternative medicine (CAM) e.g., Chinese medicine (n=5), multidisciplinary care (n=4), and phototherapy/laser modalities (n=4). Interventions identified for SSc included physical exercise e.g., hand, oral and general exercise (n=21), phototherapy/laser modalities or shockwave therapy (n=15), patient education and self-management (n=10), CAM (n=8), hand-bathing e.g., in paraffin (n=5), manual therapy e.g., osteopathic manipulative treatment (n=5), dietary therapy and nutrition (n=5), oral hygiene (n=2), hyperbaric oxygen or ozone therapy (n=2) and multidisciplinary care (n=2). Target health domains and organ systems identified within SLE included (in descending order) (i) disease activity, (ii) health-related quality of life (HRQoL), (iii) depression/anxiety, (iv) fatigue, (v) organ damage, (vi) inflammatory markers, (vii) psychological stress, (viii) pain, (ix) body composition/anthropometry, and (x) aerobic capacity. Intervention targets in SSc included (i) functional impairment e.g., hand mobility, (ii) skin sclerosis including microstomia, (iii) HRQoL, (iv) pain, (v) circulation e.g., Raynaud’s phenomena and telangiectasias, (vi) skin ulcers, (vii) oral hygiene, (viii) fatigue, (ix) digestion, and (x) depression/anxiety. Conclusion Physical exercise was a frequently researched non-pharmacological intervention within both SLE and SSc. While psychological support and dietary therapy/nutrition were frequently investigated in SLE, phototherapy modalities were common in SSc. Patient education and self-management was advocated in both SLE and SSc literature. HRQoL was a frequent target domain in both diseases; while disease activity and psychosocial domains emerged as important targets in SLE, functional impairment and skin-related aspects constituted predominant targets in SSc. Efficacy of interventions varied considerably across studies. Current evidence is limited by the overall small study populations, and the lack of large RCTs. Table 1. Studies categorised by design. Study design SLE SSc Meta-analysis of RCTs 5 1 RCT (including long-term follow-up or post-hoc analysis) 41 28 Non-randomised longitudinal controlled/cohort studies 28 7 Retrospective cohort study, cross-sectional or case-control study 16 2 Case series or open pilot studies 21 37 Acknowledgements The authors would like to thank the members of the EULAR task force for recommendations/points to consider for the non-pharmacological management of systemic lupus erythematosus and systemic sclerosis (in alphabetical order by family name) i.e., Helene Alexanderson, Laurent Arnaud, Oliver Distler, Andrea Domján, Els van den Ende, Kim Fligelstone, Agnes Kocher, Maddalena Larosa, Martin Lau, Alexandros Mitropoulos, Mwidimi Ndosi, Gunilla von Perner, Janet Poole, Anthony Redmond, Valentin Ritschl, Yvonne Sjöberg, Tillmann Uhlig, Cecília Varjú, Joke Vriezekolk, Elisabet Welin, and Rene Westhovens, for their contribution to the formulation of the research questions together with IP, CG, TS and CB. Disclosure of Interests None declared